Friday, June 25, 2010

After 4 failed IVF cycles, what should I do next ?

Mrs Desai was in tears. She was very depressed and agitated. " Doctor, I have done 4 IVF cycles in 3 different clinics and they have all failed ! What should I do next ? Is there any hope for me at all ?"

I see patients like Mrs Desai every day. I try to help them analyse their problem , so they can find the right solution.

Step No 1 is to use the McKinsey MECE model of exploring all their options - making a list which is mutually exclusive and completely exhaustive. In most cases, this list would include the following options:- childfree living- adoption- medical treatment ( IVF)- third party reproduction ( IVF with donor eggs or donor embryos or surrogacy)

Typically, most patients who come to me are willing to consider only the last 2 options.

As I explain to them , for their next IVF cycle, there are only 5 things that they can change -the eggs ( donor eggs)the sperm ( donor sperm )the embryos ( donor embryos)the uterus ( surrogacy)orthe doctor.

If the eggs, sperm and the uterus seem fine, then often the best option is to change the doctor !

Sometimes patients are reluctant to do this. They have invested a lot of time and money and energy in their IVF treatment and they feel that their doctor "knows their case", so it's best to stick with him. Also, many IVF clinics are very good at "holding" on to their patients. They will refuse to give the medical records of the IVF treatment, which means that patients are often clueless as to what has happened in their earlier IVF cycles and and are forced to continue with the old clinic. Also , finding a new doctor is hard work - and patients who have developed a good rapport with their doctor feel they are being disloyal to him by going to another clinic. For others, it's just plain inertia. Better the known devil than the unknown one - and isn't this clinic the best anyway ? So what's the point of going to another doctor ? What value can he add or what can he do differently ?

There are may benefits to changing doctors. For one , the new doctor provide a fresh perspective, and may be able to identify problems the previous doctor has missed. For example, many IVF clinics still do not test ovarian reserve properly, and often fail to diagnosis patients with poor ovarian reserve correctly. Secondly, the new doctor may have special expertise in dealing with your particular problem. Thus, while many IVF clinics do offer PESA and TESE for male factor infertility, the quality of these ancillary services is often poor, because they do not have a full-time embryologist or andrologist on staff. Thirdly, the new doctor can offer options which the earlier clinic was not able to ( for example, vitrification or embryo biopsy). Finally, being able to achieve a pregnancy for a patient who has failed IVF treatment in another clinic is a matter of pride for many IVF doctors, so you are likely to get VIP attention !

Have you failed IVF treatment ? Not sure what to do next ? I'll be happy to provide a free second opinion, so you know you are on the right track !